The US Preventive Services Task Force recommends that all adults age 50 and older be screened for colorectal cancer with colonoscopy increasingly being utilized as the primary screening method. Capacity to perform colonoscopy may exceed demand, particularly in rural communities who do not have GI specialists. Preliminary data shows that 85% of endoscopy procedures in rural Oregon hospitals are screening colonoscopies and that these colonoscopies are predominantly performed by generalist physicians. Little is known about the utilization and quality of colonoscopy in rural primary care settings. This proposal is designed to document the quality of screening and diagnostic colonoscopies occurring in rural Oregon. CORI (Clinical Outcomes Research Initiative) has created a consortium of 86 adult GI practice sites in 28 states which use a computerized endoscopic procedure report generator to create colonoscopy reports. This software will be used to measure 10 quality indicators in 24 rural Oregon practices performing screening colonoscopy. Specific aim 1: We will form a rural colonoscopy consortium and install the CORI software in 24 rural sites in Oregon to collect routine practice data. Specific aim 2: We will compare the performance of colonoscopy in rural Oregon to the national CORI consortium and to evidence-based standards on indicators of exam quality. Among the 10 quality indicators are cecal intubation rate, colonoscope withdrawal time, bowel preparation, polypectomy rates, rates of unplanned events, and documentation of follow-up recommendations. Results of these indicators in our rural Oregon practice consortium will be compared to those results in the National Endoscopic Database, which is largely compiled of experienced gastroenterologists in urban practice. This will also allow comparison of rural community practice with performance of colonoscopy principally by generalist physicians as compared to that performed by gastroenterologists. Summary: Efforts to improve colorectal cancer screening rates require increasing the current capacity to perform colonoscopy. Evaluating practice performance quality of colonoscopy in rural areas and by non-gastroenterologists will provide important guidance in determining whether this is a feasible national strategy for increasing colonoscopic capacity.Project Narrative Efforts to improve colorectal cancer screening rates require increasing the current capacity to perform colonoscopy. Evaluating practice performance quality of colonoscopy in rural areas and by non-gastroenterologists will provide important guidance in determining whether this is a feasible national strategy for increasing colonoscopic capacity.